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Posts tagged ‘neuro’

Urinary incontinence and pelvic organ prolapse can have a significant physical, social and psychological for many women. There are a number of solutions in the management of these problems.

The process of urination and its control depend on an intact neuromuscular system. The bladder is made up of smooth muscle – the detrusor muscle, while the urethra has smooth muscles with a band of striated muscle. Both the somatic and autonomic nervous systems provide innervation to these muscles. The bladder muscle must contract while the urethral sphincter relaxes during urination. It works best when the two are coordinated. The pelvic floor musculature consists of striated muscle fibres innervated by the pudendal nerve. By supporting the bladder and helping to lengthen the urethra, the pelvic floor muscles assist the passage of urine and its control.

Electrical stimulation is a modality that physiotherapists use to treat a variety of conditions. Electrical stimulation is used to restore normal physiological reflex mechanisms in abnormal nervous systems and muscles, as well as to strengthen striated muscles. Using Electro therapy, we try to stimulate the fibres of the pelvic (S2-S4), hypogastric (T10-L2), and pudendal nerves. It is believed that electrical stimulation can inhibit detrusor activity by activating inhibitory nerve fibres in the sympathetic hypogastric nerve, and inhibiting parasympathetic excitatory nerves in the pelvic nerve. It is also used to stimulate and strengthen the striated muscles of the pelvic floor via the pudendal nerve.

Routinely used machines are the interferential electrical stimulation machine and intra-vaginal stimulation machines. The Empi Intravaginal Stimulation Unit is a unit providing neuromuscular stimulation that can be used at home by the patient. The unit consists of a compact battery operated stimulator has two independent channels. One channel operates at 125 Hz to promote bladder inhibition; the other operates at 50 Hz to stimulate muscle contraction. Both channels can be used separately, or together. The electrode is a soft, silicone rubber cylinder about the size of a tampon. The electrode can be easily inserted and the patient learns how to take proper care of it. The therapist adjusts the settings on the stimulator and then the patient is taught how to control the intensity. The intensity should be high enough to cause a muscle contraction but within the patient’s comfort limits.

Many of the patients with incontinence have weakened musculature contributing to their urinary incontinence. Their symptoms often improve when they follow their prescribed exercise program and have adequate strength. Electrical stimulation is indicated when they have strength less than ‘fair’ as measured during a manual muscle test. It may also be indicated to provide sensory stimulation for patients with urge incontinence.

It is always advisable to seek medical help and undoubtedly a good session with your women’s health physiotherapist is the best way for you to learn correct techniques.